Saturday, October 6, 2007

Bioethics Recommendations?

Does anyone have any recommendations for good texts and/or anthologies for a "bioethics" course largely for non-major undergraduates?

I realize that "bioethics" is a big tent field (see NYU's new program in bioethics, which looks really cool for many reasons), so a wide variety of topics could be covered in such a course with that title. While I suppose I'll have to cover some bioethical issues that arise from recent technological developments, I hope to do more on low-tech bioethical issues that arise when you look at things from the position of those worst off.

The standard text problem is that many anthologies are geared more toward advanced students and beyond, and I suspect are beyond the current reach of many undergraduates.

Any suggestions, anyone? Thanks in advance.

I'll add a plug for Bernard Rollin's recent Ethics and Science, which I read recently and enjoyed very much.


  1. Beauchamp and Childress, Principles of Biomedical Ethics, is pretty standard. Their particular approach (which they or others have dubbed "principlism") has pretty strongly influenced the discourse of both academic and clinical bioethics, so students who have read it will be made "literate" in certain broadly accepted ways of speaking.

    Their final chapters (if I recall correctly) deal with questions of policy, aiming to apply the framework they have developed to "systemic" issues. Unless they've updated it, those chapters are most likely both out of date and most closely related to what you want to talk about. But maybe they have in fact updated it....

    I've never been satisfied with making that book the center of a course, though it was useful when combined with other things. Here are two slightly eclectic suggestions: Susan Sontag, Illness as Metaphor; Ivan Illich, Medical Nemesis.

    Sontag compares the mythologizing surrounding cancer in her day (the early 1970s) to the complex network of images, practices, and institutions that grew up around tuberculosis in the 19th century. Very interesting, and a usefully different perspective to introduce into a course that can all too easily devolve into a kind of policy seminar.

    Illich is usefully different in a very different direction, summoning all his learning and passion to denounce the industrialization of health and the psychic or cultural wounds that brings with it. He's uncompromising and perhaps a bit wild, but the book is a potent tonic for stirring up the moral imagination. Since most students will come in with the attitude that technological progress, especially in health care, has been an unqualified good, Illich can rouse them to be more critical in a way that Beauchamp and Childress really do not.

    Both these books are rhetorically quite powerful; the writers are not addressing either children or wonks, and above all not undergraduates in philosophy. I think (and have found) that that makes them good for the kind of class you describe.

  2. Nathan, I use Biomedical Ethics, 6th Edition edited by Thomas Mappes and David DeGrazia. There's more there than you will ever be able to use in a course, but all the classic articles are there (Rachels on euthanasia, Thomson on abortion, and so on). The other nice thing the book has is a bunch of articles about problems and benefits of healthcare systems around the world that I use to end off the course with a discussion of the ethics of our healthcare "system". With the upcoming debate on healthcare in the next election, it could make the course very timely for the students.

  3. My political philosophy intro class (taught by Norman Daniels, back in 1995) was generally very good, but it definitely introduced a problematic element about bioethics, during the health care unit. The desire to keep the discussion abstract and above the bounds of policy discussion seemed appropriate for a philosophy class, and yet this approach slyly placed a whole set of views out of bounds. Specifically, I lost count of the number of times a class discussion went something like:

    Me: If you think people have a right to X, then you should support more market forces in health care, because socialized systems provide X badly.

    Classmate (or TA): Let's not discuss policy. Stick to the framework.

    In other words, the whole free-market critique of socialized medicine systems, from Medicare to European and Canadian ones, was unacceptable, because it depended too much on the details of how the world actually works. Hence it is difficult to find purely philosophical literature supporting this view; one has to look at the economics or policy literature, and that seems out of place in a philosophy class, I guess. It seems that bioethics discussions depend so much on priors not just having to do with moral intuitions but also just about what one thinks is the actual case in the world. If someone really thinks that there are 43 million uninsured people in the U.S., that will lead down a particular thought path; if someone else has read that the real number of uninsured in the U.S. is closer to 8 million, that will lead down another. Yet, again, that seems off topic for a bioethics class.

    I don't really know how to solve this problem.

  4. The Beauchamp & Childress approach has dominated academic bioethics as Gregory has said so it needs to be mentioned and dealt with. However I think it is too dense for a course like the one suggested.

    Instead I would go with a reader of some kind (And there are plenty of them) and then pick the topics you want to discuss out of it. This is largely what I do.

    Ananda, I agree the perspective shouldn't be avoided but instead should be addressed. But I don't think it is a disciplinary avoidance of the practical that is why there is little literature on the sort of approach you are suggesting (though see Tristian Englehardt's work). Instead it is that in this case the free market approach seems entirely inappropriate given the relevant facts of the matter. It is startling that America as the country that perhaps exemplifies the free market approach to health care does so poorly on most measures. It is of course unsurprising when you recognise that aspects of medical care make it a place that free market logic is not going to work well.


  5. It is startling that America as the country that perhaps exemplifies the free market approach to health care does so poorly on most measures.

    See, this pretty much sums up the difficulty I was referring to. We could get into a discussion about what counts as "most measures" (e.g., if cancer or hepatitis survival rates, or speed of drug development from lab to patient, are considered, the U.S. does better than any European state or Canada; only when statistics such as life expectancy, whose causative influences are far broader in scope than just health care policy, are used as the metric does the U.S. suffer in comparison. But that would be declared out of discussion scope in most bioethics seminars. Instead, your view would be taken as given. Only in bioethics (from my experience) are empirical propositions given weight comparable to "priors" in other philosophical subdisciplines. It just is not the case that the "relevant facts of the matter" are as settled for bioethics as they are for, say, epistemology (I take it we can all agree there is no present King of France!), but to get into those details takes away from the *philosophical* content of the course. Whether it is appropriate for a teacher of bioethics to be unaware of international comparisons of cancer survival rates, or of organ transplant survival rates, is another issue.

    It is of course unsurprising when you recognise that aspects of medical care make it a place that free market logic is not going to work well.

    This came up in the same class I mentioned before; when I asked for specifics, the prof gave the example of adverse selection in insurance pools. As it happens, there is no actual empirical evidence suggesting adverse selection plays a significant role in health care prices, but apparently the theoretical possibility was enough to condemn the free market approach.


If you wish to use your name and don't have a blogger profile, please mark Name/URL in the list below. You can of course opt for Anonymous, but please keep in mind that multiple anonymous comments on a post are difficult to follow. Thanks!